JP2007501076A - Artificial organs - Google Patents

Artificial organs Download PDF

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Publication number
JP2007501076A
JP2007501076A JP2006522743A JP2006522743A JP2007501076A JP 2007501076 A JP2007501076 A JP 2007501076A JP 2006522743 A JP2006522743 A JP 2006522743A JP 2006522743 A JP2006522743 A JP 2006522743A JP 2007501076 A JP2007501076 A JP 2007501076A
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JP
Japan
Prior art keywords
replacement device
lamina
prosthesis
bumper
inferior facet
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Granted
Application number
JP2006522743A
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Japanese (ja)
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JP4500311B2 (en
Inventor
ベリー,ブレット・エム
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ウォーソー・オーソペディック・インコーポレーテッド
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Publication date
Priority to US10/635,622 priority Critical patent/US7377942B2/en
Application filed by ウォーソー・オーソペディック・インコーポレーテッド filed Critical ウォーソー・オーソペディック・インコーポレーテッド
Priority to PCT/US2004/025402 priority patent/WO2005013864A2/en
Publication of JP2007501076A publication Critical patent/JP2007501076A/en
Application granted granted Critical
Publication of JP4500311B2 publication Critical patent/JP4500311B2/en
Application status is Expired - Fee Related legal-status Critical
Anticipated expiration legal-status Critical

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    • A61B17/58Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7062Devices acting on, attached to, or simulating the effect of, vertebral processes, vertebral facets or ribs ; Tools for such devices
    • A61B17/7064Devices acting on, attached to, or simulating the effect of, vertebral facets; Tools therefor
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    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2220/00Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2220/0025Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2220/0075Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements sutured, ligatured or stitched, retained or tied with a rope, string, thread, wire or cable
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2310/00Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
    • A61F2310/00005The prosthesis being constructed from a particular material
    • A61F2310/00011Metals or alloys
    • A61F2310/00017Iron- or Fe-based alloys, e.g. stainless steel
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2310/00Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
    • A61F2310/00005The prosthesis being constructed from a particular material
    • A61F2310/00011Metals or alloys
    • A61F2310/00023Titanium or titanium-based alloys, e.g. Ti-Ni alloys
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2310/00Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
    • A61F2310/00005The prosthesis being constructed from a particular material
    • A61F2310/00011Metals or alloys
    • A61F2310/00029Cobalt-based alloys, e.g. Co-Cr alloys or Vitallium
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2310/00Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
    • A61F2310/00005The prosthesis being constructed from a particular material
    • A61F2310/00179Ceramics or ceramic-like structures

Abstract

【課題】1つ又は複数の椎骨後部構造体が切除されて残った空間に間置するための人工器官を提供する。 A one or more vertebral rear structure provides a prosthesis for interposition in the remaining space is cut.
【解決手段】人工器官は、切除された椎弓板に置き換えるための下部分を有する椎弓板ブリッジと、切除された下関節突起に置き換えるために、椎弓板ブリッジの下部分に接続されている少なくとも1つの下関節面置換装置と、切除された上関節突起に置き換えるための少なくとも1つの上関節面置換装置と、を備えている。 A prosthesis includes a lamina bridge with the lower portion for replacing the lamina excised, to replace the inferior articular excised, is connected to the lower portion of the lamina bridge It comprises at least one inferior facet replacement device, and at least one upper articulation surface replacement device for replacing the articular on the resected and are. 少なくとも1つの上関節面置換装置は、少なくとも1つの下関節面置換装置と関節運動を行う。 At least one of the upper articular surface replacement device performs at least one inferior facet replacement device and articulation.
【選択図】図1 .FIELD 1

Description

本発明は、概括的には脊椎外科処置装置に、より厳密には脊椎の後部要素の置換に関する。 The present invention relates to spinal surgical apparatus in general, and more precisely relates to substitution of posterior elements of the spine.

様々な傷害及び変形により、椎弓根(pedicles)、椎弓板(laminae)、関節突起(articular processes)及び棘突起(spinous processes)を含む椎骨の後部構造に損傷が発生することがある。 The various injuries and variations, pedicle (pedicles), lamina (laminae), damage to the rear structure of the vertebrae including articular (articular processes) and spinous (spinous processes) may occur. このような傷害及び変形に付随する痛みと身体活動の不自由さを改善するため、1つ又は複数の後部椎骨構造体を外科処置により切除し、人工器官に置き換えることもある。 To improve the inconvenience of pain and physical activity associated with such injuries and variations, one or more rear vertebral structure excised surgically, also be replaced by a prosthesis. 例えば、加齢、疾病又は傷害により、椎間円板が潰れて椎体同士が実際に接触する場合もある。 For example, aging, the disease or injury, in some cases the intervertebral disc is the vertebral bodies collapse is actually in contact. このような事態は、負荷、磨耗、損傷が増す原因となり、面関節のような1つ又は複数の関節、又は椎弓板に痛みを引き起こし、関節面の外科的除去即ち関節突起切除、及び/又は椎弓板の外科的除去即ち椎弓板切除が行われる結果を招きかねない。 Such a situation, load, wear, cause damage increases, one or more joints, such as facet joints or causing pain to the lamina, surgical removal ie articular resection of the articular surface, and / or surgical removal i.e. lamina excision of the lamina is may lead to results that are performed.

脊椎関節突起切除術(facetectomy)又は椎弓切除術(laminectomy)で除去された構造体に置き換えるために使用されている現在の人工器官では、結果的に、面関節が動かなくなるか、又は別の極端な場合には、脊柱が過剰に動くようになるか、の何れかになりかねない。 Spinal articular resection (facetectomy) or laminectomy Current prostheses are used to replace the structure removed in (laminectomy), consequently, the facet joints can not move, or another in extreme cases, or spine is to move excess, could lead to either. 従って、関節突起切除術又は椎弓切除術後の脊柱に対してより自然な動きを復元させる装置が必要とされている。 Thus, apparatus for restoring a more natural movement against articular resection or laminectomy surgery of the spine is required.

本開示は、1つ又は複数の椎骨後部構造体が切除されたことにより残る空間に間置(interposition)するための人工器官に関する。 The present disclosure relates to prosthetic for one or more of vertebral rear structure body is interpositional (Interposition) in the space left by the resected. 或る実施形態では、人工器官は、切除された椎弓板に置換するための下部を有する椎弓板ブリッジと、切除された下関節突起に置換するための、椎弓板ブリッジの下部に接続された少なくとも1つの下関節面置換装置と、切除された上関節突起に置換するための少なくとも1つの上関節面置換装置と、を備えている。 In one embodiment, the prosthesis is connected to the lamina bridge with bottom for replacing the lamina excised, to replace the inferior articular excised, the lower portion of the lamina bridge comprises at least one inferior facet replacement device is, and at least one upper articulation surface replacement device for replacing the articular on the resected. 少なくとも1つの上関節面置換装置は、少なくとも1つの下関節面置換装置と関節運動を行う。 At least one of the upper articular surface replacement device performs at least one inferior facet replacement device and articulation.

別の実施形態では、複数レベルの人工器官は、少なくとも1つの第1下関節面置換装置に接続された第1椎弓板ブリッジと、少なくとも1つの上関節面伸張部に接続された第2椎弓板ブリッジと、を備えている。 In another embodiment, multiple levels of prostheses includes a first lamina bridge connected to at least one of the first lower articular surface replacement device, a second vertebral connected to at least one of the upper articular surface extension portion It is provided with a bow plate bridge, the. 少なくとも1つの下関節面置換装置は、少なくとも1つの上関節面伸張部と関節運動を行う。 At least one inferior facet replacement device performs the articulation at least one upper articulation surface extension portion. 別の実施形態では、少なくとも1つの経椎弓板ファスナが第1椎骨の椎弓板を通って伸張し、これに接続されており、少なくとも1つの下関節面置換装置が経椎弓板ファスナに接続されている。 In another embodiment, extends at least one through lamina fastener through the lamina of the first vertebra, is connected thereto, at least one inferior facet replacement device within transforaminal lamina fastener It is connected.

別の実施形態では、本開示は、脊柱に対する侵襲性をできる限り抑えて、少なくとも1つの経椎弓板ファスナと少なくとも1つの下関節面置換装置とを有する人工関節面器官を取り付けるための装置に関する。 In another embodiment, the present disclosure is suppressed as much as possible invasiveness to spinal relates to a device for attaching the artificial joint surfaces organ having at least one through laminae fastener and at least one inferior facet replacement device . この実施形態では、装置は、少なくとも1つの経椎弓板ファスナを脊柱の1つの椎骨の椎弓板の近くに進入させ、この少なくとも1つの経椎弓板ファスナを椎弓板内に伸張させるための、第1管状部材を備えている。 In this embodiment, the apparatus, at least one through lamina fastener is advanced close to the lamina of one vertebra of the spinal column, the at least one through laminae fastener for stretching in the lamina of, and a first tubular member. 少なくとも1つの経椎弓板ファスナの接続部分は、椎弓板を通って伸張している。 Connecting portions of the at least one through lamina fastener is extending through the lamina. この実施形態は、少なくとも1つの下関節面置換装置を、少なくとも1つの経椎弓板ファスナの接続部分に接続するための第2管状部材を更に備えている。 This embodiment further includes a second tubular member for connecting at least one inferior facet replacement device, the connecting portion of the at least one through lamina fastener.

本発明の原理の理解を深めるために、これより図面に示した実施形態又は実施例について特別な用語を使いながら説明する。 For a better understanding of the principles of the present invention will be described while using specific terms the embodiments or examples shown now to the drawings. しかしながら、これによって本発明の範囲を限定するものではない。 However, this does not limit the scope of the present invention. 本発明が関係する技術分野における当業者であれば、ここに説明している実施形態に対する様々な変更及び修正、並びに本願に示す発明原理の別の使用例が、当然のこととして想起されるであろう。 Those skilled in the art to which this invention pertains, that various changes and modifications to the embodiments described herein, as well as other uses of the invention principle shown herein may be recalled as a matter of course It will allo.

まず図1では、参照番号10は脊柱を表しており、第1の損傷した椎骨12が上椎骨14と下椎骨16の間に伸張している。 First, in FIG. 1, reference numeral 10 represents a spinal column, first damaged vertebra 12 is stretched between the upper vertebra 14 and a lower vertebra 16. 損傷した椎骨12の後部構造は、椎弓根12cと12dに支えられている上関節面12a及び12bと、椎弓根12cと12dの間を伸張する一対の椎弓板12e及び12fと、椎弓板12eと12fの接合部から背面方向に突き出している棘突起12gと、椎弓板12eと椎弓根12c並びに椎弓板12fと椎弓根12dそれぞれの接合部から支えられている下関節面12h及び12iと、を含んでいる。 Rear structure of the damaged vertebra 12 includes an upper articular surface 12a and 12b which are supported on the pedicle 12c and 12d, a pair of lamina 12e and 12f extending between the pedicle 12c and 12d, vertebral and spinous 12g from the junction of lamina 12e and 12f protruding towards the back, the laminae 12e and pedicle 12c and lamina 12f and pedicle 12d below are supported from each of the junction joint and it includes a plane 12h and 12i, a. これら後部構造体は椎孔18を跨いでいる。 These rear structure is across the vertebral foramen 18.

代表的な外科処置的椎弓切除術では、椎弓板12eと12fが棘突起12gと共に切除され、上椎骨14と下椎骨16の後部構造体同士の間に空隙が作り出される。 In a typical surgical manner laminectomy, the lamina 12e and 12f are cut with spinous 12g, gap between the adjacent rear structure of the upper vertebra 14 and the lower vertebra 16 is created. 外科処置的脊椎関節突起切除術は、下関節面12hと12iの除去を含んでおり、隣接する椎骨16の上関節面16aと16bの除去を含む場合もある。 Surgical spinal articular resection includes a removal of the lower articular surface 12h and 12i, which may include removal of the upper articular surface 16a and 16b of the adjacent vertebrae 16. 椎弓切除術は、関節突起切除術と共に行われる場合もあり、2つ以上の椎骨の後部構造体の除去を含む場合もある。 Laminectomy is sometimes performed in conjunction with articular resection, which may include removal of the rear structure of two or more vertebrae. その後、本発明の或る実施形態による人工器官アッセンブリが、切除された1つ又は複数の後部構造体に置き換えられる。 Thereafter, the prosthesis assembly according to an embodiment of the present invention is replaced by one or more posterior structures were excised.

次に図2に示すように、本発明の或る実施形態による後部人工器官アッセンブリは、椎骨12(図1)の椎弓切除術、椎骨12(図1)の下関節突起切除術、及び椎骨16(図1)の上関節突起切除術、を含む外科処置の後に使用される。 Next, as shown in FIG. 2, the rear prosthesis assembly according to an embodiment of the present invention, laminectomy of the vertebra 12 (Fig. 1), inferior articular resection of the vertebra 12 (Fig. 1), and vertebral 16 superior articular resection (Fig. 1), is used after surgical procedures, including. 後部人工器官アッセンブリ22は、全体を参照番号20で示しており、一対の椎弓根スクリュー24と26、一対の下関節面置換装置28と30、一対の上関節面置換装置32と34、及び棘突起バンパ36に接続された椎弓板ブリッジ22を含んでおり、全ての要素は以下に説明するやり方で接続される。 Rear prosthesis assembly 22 is shown generally by reference numeral 20, a pair of pedicle screw 24 26, a pair of inferior facet replacement device 28 30, a pair of superior articular surface replacement device 32 34 and, includes lamina bridge 22 connected to the spinous process bumper 36, all the elements are connected in a manner to be described below.

椎孔18(図1)を横切って跨ぐように作られている椎弓板ブリッジ22は、端部分40と42を有するプレート38を含んでいる。 Vertebral foramen 18 (FIG. 1) lamina bridges 22 are made so as to straddle across includes a plate 38 having an end portion 40 and 42. 人工棘突起器官44は、プレート38の略中心部から背部方向に伸張している。 Artificial spinous organ 44 extending from a substantially central portion of the plate 38 in the back direction. 実施例の中には、プレート38がアーチ状であるものもあるし、比較的平坦な形状のものもある。 Some of the embodiments, to and some plates 38 are arcuate, and some of the relatively flat shape. 椎弓板ブリッジ22は、各種材料で作ることができ、例えば、チタニウム、ステンレス鋼、又は英国のVictrex PLCから供給されているポリエーテルエーテルケトン(PEEK TM )(登録商標)のような放射線透過性ポリマー材料で作ることができる。 Lamina bridge 22 can be made of various materials, for example, titanium, stainless steel, or British polyetheretherketone, supplied by Victrex PLC (PEEK TM) radiolucent such as (R) it can be made of a polymer material. 選択された材料、及び後部人工器官アッセンブリ20の許容運動量次第で、椎弓板ブリッジ22には剛体であってもよいし、剛体でなくてもよい。 The materials chosen, and depending on the allowable momentum of the rear prosthesis assembly 20 may be a rigid body in the lamina bridge 22 may not be rigid.

椎弓板ブリッジ22の端部分40と42には、それぞれ、椎弓根ねじ24と26を受け入れるねじ孔46と48が設けられている。 The end portions 40 and 42 of the lamina bridge 22, respectively, the screw holes 46 and 48 for receiving a pedicle screw 24 and 26 is provided. 椎弓根ねじ24と26は、椎弓根12cと12d(図1)に螺合するように作られている。 Pedicle screws 24 and 26 are designed to be screwed into the pedicle 12c and 12d (FIG. 1). 実施形態の中には、椎弓根ねじの代わりに、埋伏型椎弓根ポスト、接着剤、又は他の椎弓根接続機構を選択している例もある。 Some embodiments, in place of the pedicle screw, impaction type pedicle post, adhesives, or other even example is selected pedicle attachment. 椎弓根ねじ24と26が装着後に椎弓根から抜け出るのを防ぐために、カバープレート(図示せず)又は当技術分野で既知の各種装置の何れでも使用することもできる。 To prevent pedicle screws 24 and 26 from escaping from the pedicle after mounting, the cover plate (not shown) or either may be used in various known devices in the art.

下関節面置換装置28と30は、下関節面12hと12iに置き換えるように作られている。 A lower articular surface replacement device 28 30 is designed to replace the inferior facet 12h and 12i. 或る実施形態では、下関節面置換装置28は、取り外し可能であり、椎弓板ブリッジ全体を交換すること無く、1つの装置28だけを後で交換できるようになっている。 In one embodiment, the lower articular surface replacement device 28 is removable, without replacing the entire lamina bridge, so that for later replace only one device 28. この実施形態では、下関節面置換装置28は、頭部50を含んでおり、そこからロッド52が伸張している。 In this embodiment, the lower articular surface replacement device 28 includes a head 50, the rod 52 from which are stretched. 頭部50は、球形であってもよいし、面関節の磨耗を低減し面関節に比較的自然な関節運動の範囲を許容するのにもっと適した解剖学的形状としてもよい。 Head 50 may be a spherical shape, may be more suitable anatomical shape to permit a range of relatively natural articulation in reduced facet joint wear facet joint. ロッド52の少なくとも一部は、管状で雌ねじ部54を備えている。 At least a portion of the rod 52 is provided with an internal thread portion 54 in the tubular. 下関節面置換装置28を製作するには、PEEK TM 、ステンレス鋼、チタニウム、コバルトクロム、亜鉛めっき、及びセラミックスを含む様々な材料を、別々に又は一緒に使用することができる。 To manufacture the inferior facet replacement device 28, PEEK TM, stainless steel, titanium, cobalt chrome, zinc plating, and a variety of materials, including ceramics, can be used separately or together. 関節面装置28は、半拘束関節に発生しかねない磨耗と衝撃を低減するために、ばね又は他の緩衝システム(図示せず)を含んでいてもよい。 Articular surface 28, in order to reduce wear and shock that may occur semi-constrained joint may comprise a spring or other buffer systems (not shown). 下関節面置換装置30の特性は、装置28と同一なので、詳しくは説明しない。 Characteristics of inferior facet replacement device 30, so the same as device 28, will not be described in detail.

椎弓板ブリッジ22の下部分からは、一対の下関節面コネクタ56と58が突き出ており、これらは下関節面置換装置28と30それぞれを受け入れるようになっている。 From the lower portion of the lamina bridge 22, it protrudes a pair of inferior facet connectors 56 and 58, which are adapted to receive a 30 each inferior facet replacement device 28. 或る実施形態では、コネクタ56は、下関節面置換装置28の雌ねじ部54と螺合するように作られた雄ねじ部60を有している。 In some embodiments, the connector 56 has a male threaded portion 60 designed to engage with the internal thread portion 54 of the lower articular surface replacement device 28. 装置30は、同様の又は同一のやり方でコネクタ58と係合する。 Device 30 is engaged with the connector 58 in a similar or identical manner. ねじ接続と説明しているが、他の実施形態では、下関節面置換装置28と30を椎弓板ブリッジ22に接続するのに、他の接続アッセンブリを使用している。 Although described with threaded connection, in other embodiments, to connect the inferior facet replacement devices 28 and 30 in lamina bridge 22, using other connection assemblies. また、下関節面置換装置28と30は取り外し可能であると説明してきたが、代わりの実施形態では、椎弓板ブリッジ22に対する永久的な付属品になっている。 Also, have been described as inferior facet replacement device 28 30 is to be removable, in an alternative embodiment, have become permanent accessories for lamina bridge 22.

下関節面置換装置28は、上関節面置換装置32と関節運動を行って、人工面関節を作り出す。 Inferior facet replacement device 28 performs the superior facet replacement device 32 and articulated creates artificial facet joint. 上関節面置換装置32は、頭部62を備えており、そこから軸部64が伸張している。 Superior facet replacement device 32 includes a head 62, the shaft portion 64 from which are stretched. 軸部64は、下椎骨16に締結されるようになっており、例えば、ねじが切られている。 Shank 64 is adapted to be fastened to the lower vertebra 16, for example, is threaded. 上関節面置換装置32は、例えば、椎弓根ねじ又は埋伏椎弓根ポストである。 Superior facet replacement device 32 is, for example, a pedicle screw or impacted pedicle post. 頭部62は、下関節面置換装置28の頭部50を受け入れるように作られたソケットであり、頭部62の形状は、下関節面置換装置28に係合するのに適している各種幾何学形状から選択される。 Head 62 is a socket designed to receive the head 50 of the inferior facet replacement device 28, the shape of the head 62, various geometry suitable for engaging the inferior facet replacement device 28 It is selected from the academic shape. 上関節面置換装置32は、チタニウム、ステンレス鋼、及びPEEK TMを含む様々な材料で作ることができる。 Superior facet replacement device 32 can be made of titanium, a variety of materials including stainless steel, and PEEK TM. 代わりの実施形態では、下及び上関節面置換装置の構成は、逆になっており、下関節面置換装置28が上関節面置換装置32のボール形状の頭部62と係合するソケットとして構成されている。 In an alternative embodiment, the configuration of the lower and the upper articular surface replacement device is reversed, configured as a socket inferior facet replacement device 28 engages the head 62 of the ball-shaped upper articular surface replacement device 32 It is. 上関節面置換装置32の特性は、装置34と同様又は同一であるので、詳しくは説明しない。 Characteristics of the upper articular surface replacement device 32, since it is similar or identical to the apparatus 34, will not be described in detail.

可撓性を有するバンパ36を、人工棘突起器官44の端部に取り付けて、隣接する椎骨(例えば、14と16)の間に伸張させ、人工棘突起器官44と隣接する両椎骨の棘突起との間の境界に緩衝作用を提供するようにしてもよい。 The flexible bumper 36 having, attached to the end of the artificial spinous organ 44, the adjacent vertebrae (e.g., 14 and 16) is stretched between the spinous processes of two adjacent vertebrae an artificial spinous organ 44 it may provide a cushioning effect at the boundary between. 或る実施形態では、バンパ36は、人工棘突起器官44の端部に外挿するように作られた中央開口66を有し、各端部に、隣接する棘突起に係合するように作られた一対のノッチ68と70を有している。 In some embodiments, bumper 36 has a central aperture 66 made in extrapolate to the end of the artificial spinous organs 44, at each end, to engage the adjacent spinous processes work It has a pair of notches 68 and 70 which are. 可撓性を有するバンパ36は、ヒドロゲルやその他エラストマー類を含め、可撓性を有する各種材料で製作することができる。 Flexible bumper 36 having, including a hydrogel or other elastomers, may be made of various materials having flexibility. 可撓性を有するバンパ36は、一旦装着されると、棘突起及び隣接する構造体を損傷させることになりかねない過剰な運動を許すこと無く、棘突起の領域内での制限された運動ができるようにする。 Flexible bumper 36 having, once mounted, without allowing excessive movement that could result in damaging the structure of the spinous process and the adjacent, is limited movement in the area of ​​the spinous process It can be so.

次に、図3は、椎骨12の椎弓切除術と、椎骨12の下関節面12hと12i及び下椎骨16の上関節面16aと16bを含む関節突起切除術との施術後の脊柱10(図1)を示している。 Next, FIG. 3, a laminectomy vertebrae 12, the spinal column 10 after treatment with articular resection including articular surface 16a and 16b on the lower articular surface 12h and 12i and the lower vertebra 16 of the vertebra 12 ( It shows Fig. 1). 後部人工器官アッセンブリ20には、ねじ切り、埋伏、又は当技術で既知の他の埋め込み法により、上関節面置換装置32と34を椎骨16の椎弓根に外科処置的に埋め込むことが伴う。 The rear prosthesis assembly 20, threaded, impaction, or by other known embedding techniques in the art, the upper joint surface replacement device 32 and 34 involves embedding a surgical manner a pedicle of a vertebra 16. 椎弓板ブリッジ22は椎弓切除術と関節突起切除術により作り出された空間に挿入され、椎弓根ねじ24と26を使って椎弓根12cと12dに締結される。 Lamina bridge 22 is inserted in the space created by laminectomy and articular resection, it is fastened to the pedicle 12c and 12d with the pedicle screws 24 and 26. なお、椎弓根ねじ24と26の代わりに椎弓根ポストのような他の型式のファスナを使用してもよい。 It is also possible to use a fastener other types, such as pedicle posts instead of the pedicle screw 24 and 26.

椎弓板ブリッジ22が椎骨12に取り付けられる前又は後の何れでもよいが、下関節面置換装置28と30が、それぞれ下関節面コネクタ56と58に螺合される。 May be either before or after the lamina bridge 22 is attached to the vertebrae 12, and 30 inferior facet replacement device 28 is screwed under the articular surface connectors 56 and 58, respectively. 下関節面置換装置28と30は、次に、上関節面置換装置32と34に可動的に係合される。 A lower articular surface replacement device 28 30 is then engaged movably engaged with the upper articular surface replacement device 32 and 34. 関節面置換装置によって形成された関節運動をする関節部は、脊柱10の動きを復元又は維持することができる。 Joint for articulation formed by the articulating surface replacement device can restore or maintain the motion of the spine 10. 椎弓板ブリッジ22は、装着されると、元の椎孔空間18を維持又は拡大する。 Lamina bridge 22, once mounted, to maintain or enlarge the original vertebral pore space 18. 次いで、可撓性を有するバンパ36の開口66は、ノッチ68と70が椎骨14と16それぞれの棘突起と可撓的に係合した状態で、人工棘突起器官44の端部に外挿して配置される。 Then, the opening 66 of the bumper 36 having flexibility, in a state where the notch 68 and 70 is engaged flexibly engaging vertebra 14 and 16 and the respective spinous process, and extrapolated to the ends of the artificial spinous process organ 44 It is placed. 図4に示す或る実施形態では、可撓性を有するバンパ36の端部は、バンパ取り付け装置72で隣接する椎骨(例えば、図1の14)の棘突起に取り付けられる。 In an embodiment shown in FIG. 4, the end portion of the bumper 36 with flexible vertebrae (e.g., 14 of FIG. 1) adjacent in the bumper mounting device 72 is attached to the spinous process of. バンパ取り付け装置72は、例えば、可撓性を有するバンパ36を通って伸張し、椎骨14の棘突起を取り巻いて又はこれを通って伸張する、ケーブルであってもよい。 Bumper attachment device 72, for example, flexibility extends through bumper 36 having, extending through it, or it surrounds the spinous process of vertebra 14 may be a cable. 椎骨16の棘突起に対して可撓性を有するバンパ36を取り付ける場合、必要に応じて、同様のバンパ取り付け装置72を、更に又は代替的に使用してもよい。 When mounting the bumper 36 having flexibility with respect to the spinous process of the vertebra 16, as needed, similar to bumper mounting device 72 may be used additionally or alternatively. このバンパ取り付け装置72により、脊柱10の動きを完全に拘束することなく、人工器官アッセンブリ20の更なる安定を図ることができる。 The bumper mounting apparatus 72, without completely restraining the motion of the spinal column 10, it is possible to further stabilize the prosthesis assembly 20.

次に図5では、椎骨12と椎骨14の椎弓切除術、及び椎骨12、14及び16の少なくとも部分的な関節突起切除術に続いて、複数レベルの後部人工器官アッセンブリ74が、脊柱10(図1)に配置されている。 Next, in FIG. 5, laminectomy vertebra 12 and vertebra 14, and subsequently to at least partial articular resection of the vertebra 12, 14 and 16, multiple levels of posterior prosthesis assembly 74, the spine 10 ( It is arranged in Figure 1). 複数レベルの後部人工器官アッセンブリ74は、第1椎弓板ブリッジ22(図2)、第2椎弓板ブリッジ76、二対の椎弓根ねじ24、26、78及び80、二対の下関節面置換装置28、30、82及び84、及び可撓性を有するバンパ36と86、を含んでいる。 Rear prosthesis assembly 74 of multiple levels, the first lamina bridge 22 (FIG. 2), a second lamina bridge 76, two pairs of pedicle screws 24,26,78 and 80, two pairs of the lower joint surface replacement device 28,30,82 and 84, and a bumper 36 of a flexible 86 includes. 椎弓板ブリッジ76は、椎弓板ブリッジ76の略中心から背部方向に伸張する人工棘突起器官88を含め、椎弓板ブリッジ22について説明した全ての構造体を備えており、更に、椎弓板ブリッジ76の上部分から突き出る一対の上関節面伸張部90と92を備えている。 Lamina bridge 76, including an artificial spinous organ 88 that extends from substantially the center of the lamina bridge 76 to the back direction, provided with all the structures described lamina bridge 22, further vertebral arch and a pair of superior articular surface extension portion 90 and 92 projecting from the upper portion of the plate bridge 76. 伸張部90と92は、それぞれ下関節面置換装置28と30と係合するよう整列している。 Expansion section 90 and 92 are aligned to engage each under the articular surface replacement device 28 and 30 and. 伸張部90は、球状又は解剖学的形状の頭部50を有する下関節面置換装置28を受け入れるように作られたソケット94を備えている。 Decompression unit 90 is provided with a socket 94 designed to receive the inferior facet replacement device 28 having a head 50 of spherical or anatomy. 頭部50がソケットである他の実施形態では、伸張部90は、ソケットと係合するように作られた頭部を備えている。 In other embodiments the head 50 is a socket, decompression unit 90 is provided with a head which is designed to engage the socket. 伸張部92は、伸張部90と同様又は同一である。 Expansion section 92 is similar or identical to the decompression unit 90. 椎弓板ブリッジ76と伸張部90と92は、例えば、チタニウム、ステンレス鋼、又はPEEK TMを含め、様々な材料で製作することができる。 Expansion section 90 and 92 and the lamina bridge 76, for example, titanium, stainless steel, or including PEEK TM, can be made of various materials.

複数レベルの後部人工器官アッセンブリ74の可撓性を有するバンパ86は、人工棘突起器官88の端部に取り付けられ、椎骨16の棘突起と可撓性を有するバンパ36の間を伸張して、人工棘突起器官88と、隣接する天然及び人工の棘突起の間の境界部に緩衝作用を提供する。 Flexible bumper 86 having a multi-level posterior prosthetic assembly 74 is attached to the end of the artificial spinous organ 88, and extending between the bumper 36 having the spinous process and the flexible vertebra 16, artificial spinous process organ 88 provides a buffering action in the boundary portion between the spinous processes of the adjacent natural and artificial. 或る実施形態では、可撓性を有するバンパ86は、椎骨16の棘突起と係合するように作られた下端ノッチ96を備えている。 In some embodiments, the flexible bumper 86 with has a lower notch 96 designed to spinous process and engage the vertebra 16. 可撓性を有するバンパ86の上端は、可撓性を有するバンパ36のノッチ70に嵌るように作られた突起部98を備えている。 The upper end of the bumper 86 having flexibility is provided with a protrusion 98 which is designed to fit into the notch 70 of the bumper 36 having flexibility. 可撓性を有するバンパ86は、ヒドロゲル又は他のエラストマー類を含め、様々な可撓性を有する材料で製作することができる。 Flexible bumper 86 having, including hydrogel or other elastomers, may be fabricated of material having a different flexibility. 可撓性を有するバンパ36と86は、上記のバンパ取り付け装置72を使って、隣接する棘突起又は人工の棘突起に取り付けることもできる。 Flexibility and bumper 36 with 86, with a bumper mounting device 72 described above, can be attached to adjacent spinous processes or artificial spinous process. 複数レベルの人工器官アッセンブリ74の別の実施形態は、3つ以上の椎弓板ブリッジと、付属の結合構造体とを含んでいる。 Another embodiment of a multi-level prosthesis assembly 74 includes three or more lamina bridges, and a coupling structure provided.

次に図6aでは、下関節面置換装置28と上関節面置換装置32により図3で形成された関節部の不自然な動きを防止し磨耗を低減するために、動作拘束機構100が採用されている。 Next, in Figure 6a, in order to reduce and prevent unnatural movement of the joint portion formed in Figure 3 by inferior articular surface replacement device 28 and the upper articulation surface replacement device 32 worn operation restraining mechanism 100 is employed ing. 或る実施形態では、動作拘束機構100は、下関節面置換装置28と上関節面置換装置32の両方を通って伸張する可撓性を有する係留紐102を備えている。 In some embodiments, operation restraining mechanism 100 includes a tether 102 having flexibility which extends through both the inferior facet replacement device 28 and the upper articulation surface replacement device 32. 係留紐を所定の位置に保持して、外科処置中に係留紐を張ることができるように、係留紐には調整機構104が取り付けられている。 Holding the tether in place, to be able to tension the tether during a surgical procedure, the adjustment mechanism 104 is attached to the tether. 追加して又は代替的に、動作拘束機構100は、下関節面置換装置28と上関節面置換装置32の両方を少なくとも部分的には取り囲む可撓性を有する鞘106を備えていてもよい。 Additionally to, or alternatively, operation restraining mechanism 100 may include a sheath 106 having at least partially surrounds the flexible both inferior facet replacement device 28 and the upper articulation surface replacement device 32. 動作拘束機構100は、鞘106を所定の位置に保持するクランプ機構108を含んでいる。 Operation restraining mechanism 100 includes a clamping mechanism 108 for holding the sheath 106 in place. 動作を拘束することに加えて、この鞘106には、関節面置換装置に磨耗屑が発生した場合にこれを入れておけるという追加の利点がある。 Operation In addition to constraining the, this sheath 106, there is an additional advantage Okeru put this if you wear debris is generated in the articular surface replacement device.

更に、追加して又は代替的に、下関節面置換装置28と上関節面置換装置32によって形成された関節部は、ヒドロゲルを使用して少なくとも部分的には拘束してもよい。 Furthermore, in addition or alternatively, the joint portion formed by the lower articular surface replacement device 28 and the upper articulation surface replacement device 32 may be restrained at least partially by using the hydrogel. 同様の又は同一の動作拘束機構100を、図3の下関節面置換装置30と上関節面置換装置34によって形成された関節部に、又は図5の複数レベルの後部人工器官アッセンブリ74の、下関節面置換装置、上関節面伸張部、又は上関節面置換装置によって形成された関節部の何れにでも、使用することができる。 Similar or identical operation restraining mechanism 100, the joint portion formed by the lower articular surface replacement device 30 and the upper articular surface replacement device 34 of FIG. 3, or a multi-level posterior prosthetic assembly 74 of FIG. 5, below articular surface replacement device, the upper articular surface extension portion, or to any of the joint portion formed by the upper articular surface replacement device may be used.

次いで図7aでは、別の実施形態として、椎骨12の下関節面12hと12i、及び椎骨16の上関節面16aと16bの関節突起切除術の後に、上関節面置換装置32と34(図2)、下関節面置換装置28と30(図2)、及び経椎弓板ファスナ110と112を使用して、関節部再建術が行われる。 Then, in Figure 7a, another embodiment, the lower joint surface 12h and 12i of the vertebra 12, and after the articular resection of superior articular surfaces 16a and 16b of the vertebra 16, the upper articular surface replacement device 32 34 (FIG. 2 ), and 30 (FIG. 2 inferior facet replacement device 28), and using a transforaminal lamina fasteners 110 and 112, joint reconstruction is performed.

図7bに示すように、経椎弓板ファスナ110は、例えば、頭部114とねじの切られたロッド116とを備えている。 As shown in FIG. 7b, Keishiyumiban fastener 110, for example, and a rod 116 which cut the head 114 and the screw. 或る実施形態では、ねじ部118は、ねじロッド116の、頭部114とは反対側の端部に形成されており、下関節面置換装置28の雌ねじ54と係合する。 In one embodiment, threaded portion 118 of the threaded rod 116, the head portion 114 is formed at the opposite end, to engage the internal thread 54 of the lower articular surface replacement device 28. ねじ部118は、例えば、機械加工ねじでもよく、その場合は、下関節面置換装置のねじ部54も機械加工ねじである。 Threaded portion 118 may be, for example, by machining a screw, in which case the threaded portion 54 of the lower articular surface replacement device is also machined screws. ねじロッド116の中央部分には、ねじ部118とはねじ山形状が異なるねじ部120がある。 The central portion of the threaded rod 116, there is a threaded portion 120 which thread form is different from the threaded portion 118. ねじ部120は、例えば、骨ねじのねじ山である。 Threaded portion 120 is, for example, a screw thread of the bone screw. 他の実施形態では、ねじロッド116は、骨ねじのねじ山のような単一のねじ山形状を使ってねじ切りされている。 In other embodiments, the threaded rod 116 is threaded with a single thread form, such as a thread of the bone screw. 下関節面置換装置28の雌ねじ54も、その単一のねじ山形状を受け入れるようにねじが切られる。 Internal thread 54 of the lower articular surface replacement device 28 is also threaded to accept the single thread form is cut.

図7aでは、上記の関節突起切除術に続いて、経椎弓板ファスナ110は、椎弓板12fにねじ込まれ、下関節面12hの以前の位置に向けて進み、更に、下関節面12hが除去されたことにより生まれた空隙内にファスナ110の少なくとも一部が伸張するまで、引き続き前進する。 In Figure 7a, following the aforementioned articular resection, Keishiyumiban fastener 110 is screwed into the lamina 12f, the flow proceeds toward a previous position of the inferior facet 12h, further the lower articular surface 12h in born by removed void until at least a portion of the fastener 110 is extended, it continues to move forward. この処置には、例えば、Magerlのねじ配置技法の一部を含め、様々な技法の何れを利用してもよい。 The treatment, for example, including a portion of the screw placement techniques Magerl, may be used any of a variety of techniques. 上関節面置換装置32は、先に述べたように装着される。 Superior facet replacement device 32 is mounted as previously described. 経椎弓板ファスナ110が椎弓板12fを通してねじ込まれた後、下関節面置換装置28が経椎弓板ファスナ110にねじ込まれる。 After Keishiyumiban fastener 110 is screwed through the lamina 12f, inferior facet replacement device 28 is screwed into the transforaminal lamina fastener 110. これで、下関節面置換装置28は、上関節面置換装置32と関節運動できるようになる。 This, inferior facet replacement device 28 will be able to superior facet replacement device 32 and articulation. 実施形態の中には、経椎弓板ファスナ110を下関節面置換装置28にねじ込んだ状態で、下関節面置換装置28が上関節面置換装置32に接続されるものもある。 In some embodiments, in a state of screwing the Keishiyumiban fastener 110 to inferior facet replacement device 28, some inferior facet replacement device 28 is connected to the upper articular surface replacement device 32.

経椎弓板ファスナ112は、経椎弓板ファスナ110と同様又は同一であるので、詳しくは説明しない。 Keishiyumiban fastener 112, since it is similar or identical to Keishiyumiban fastener 110 will not be described in detail. 経椎弓板ファスナ112の設置は、経椎弓板ファスナ110に関して上に説明したのと同様のやり方で進められ、ファスナ112は、椎弓板12eを通してねじ込まれ、下関節面置換装置30と係合する。 Installation of Keishiyumiban fastener 112 is advanced in a manner similar to that described above in reference to Keishiyumiban fastener 110, the fastener 112 is threaded through the lamina 12e, engagement with the inferior articular surface replacement device 30 to focus.

或る実施形態では、上記の関節部再建術は、経皮的に、侵襲性をできる限り抑えて、又は筋肉構造の破壊を避けるために画像案内式技法を使って行われる。 In some embodiments, the joints reconstruction are transdermally, by suppressing as much as possible invasive or performed using image guided techniques in order to avoid disruption of the muscle structure. 例えば、図8では、経椎弓板ファスナ110と112、下関節面置換装置28と30、及び上関節面置換装置32と34を配置するのに、一連の管又は管状部材が使用されている。 For example, in FIG. 8, Keishiyumiban fasteners 110 and 112, inferior facet replacement devices 28 and 30, and to place the superior facet replacement devices 32 and 34, a series of tubes or tubular members are used . 第1管122は、経椎弓板ファスナ110を通過させることができる最小寸法の直径を有しており、この管122を経皮的に挿入して椎弓板12e(図1)まで伸張させる。 The first tube 122 has a diameter of the smallest dimension that can be passed through Keishiyumiban fastener 110, thereby stretching the tube 122 to percutaneously insert and lamina 12e (FIG. 1) . 経椎弓板ファスナ110は、第1管122を通して、上記のように設置される。 Keishiyumiban fasteners 110, through the first pipe 122 is installed as described above. 第1管122は椎弓板12eから横方向に遠ざかる方向に伸張している。 The first pipe 122 is stretched in a direction laterally away from the lamina 12e. 経椎弓板ファスナ112を移植するのにも、同様の又は同一の管124が用いられる。 Also to implant the Keishiyumiban fastener 112, similar or the same tube 124 is used. 第2管126は、下及び上関節面置換装置28と32を通過させることができる最小寸法の直径を有しており、この管126を経皮的に挿入して、関節面12hと16a(図1)の関節突起切除術で作り出された空隙部まで伸張させる。 The second tube 126 has a diameter of the smallest dimension that can be passed through the lower and upper articulating surfaces replacement devices 28 32, the tube 126 and inserted percutaneously, articular surfaces 12h and 16a ( Figure 1) is stretched to the gap portion, produced by articular resection. 下及び上関節面置換装置28及び32は、第2管126を通して、上記のように設置される。 Below and above the articular surface replacement device 28 and 32, through the second pipe 126 is installed as described above. 第2管126は、椎弓板12eから背部方向に遠ざかる方向に伸張している。 The second tube 126 is extended in a direction away from the lamina 12e in the back direction. 下及び上関節面置換装置30及び34を移植するのにも、同様の又は同一の管が用いられる。 To implant the lower and the upper articular surface replacement device 30 and 34, similar or identical tubing is used. 管122、124、126及び128は、人工構造体の設置に必要であればどの様な長さでもよい。 Tubes 122, 124, 126 and 128 can be any kind of length if necessary to the installation of the artificial structure. 例えば、第1管122は相対的に長く、一方で第2管は相対的に短くてもよい。 For example, the first pipe 122 is relatively long, whereas in the second tube may be relatively short.

以上、本発明の代表的実施形態を数例のみ詳しく説明してきたが、当業者には容易に理解頂けるように、本発明の革新的教示と利点から実質的に逸脱することなく、これら代表的実施形態に対して多くの変更を加えることができる。 Although the exemplary embodiment of the present invention have been described only a few examples in detail, as able readily apparent to those skilled in the art, without departing substantially from the innovative teachings and advantages of the present invention, these typical You can make numerous modifications to the embodiments. 従って、そのような変更は、全て特許請求の範囲に定義する本発明の範囲に含まれるものとする。 Accordingly, such modifications are intended to be included within the scope of the invention as defined by the scope of the appended claims. 各請求項において、手段プラス機能の節は、列挙している機能を実行するものとしてここに説明している構造体を網羅することを意図としており、構造的等価物だけではなく等価な構造体もその対象と考えている。 In the claims, means section plus function is for the intention is to cover the structures that are described herein as performing the functions listed, not only structural equivalents equivalent structures It is also considered the subject.

後部要素が損傷している椎骨を有する脊柱の斜視図である。 Is a perspective view of a spinal column having a vertebrae rear element is damaged. 本発明の或る実施形態による椎骨移植片アッセンブリの分解斜視図である。 It is an exploded perspective view of a vertebral implant assembly according to an embodiment of the present invention. 脊柱に配置された図2の人工器官の斜視図である。 It is a perspective view of the prosthesis of Figure 2 arranged in the vertebral column. 本発明の第2の実施形態による、脊柱内に配置し、椎骨の後部要素に置き換えるよう構成された、人工器官の斜視図である。 According to a second embodiment of the present invention, positioned within the spinal column, which is configured to replace the posterior elements of the vertebrae is a perspective view of the prosthesis. 本発明の第3の実施形態による、脊柱内に配置し、椎骨の後部要素に置き換えるよう構成された、人工器官の斜視図である。 According to a third embodiment of the present invention, positioned within the spinal column, which is configured to replace the posterior elements of the vertebrae is a perspective view of the prosthesis. 係留紐を有する関節面置換アッセンブリの分解斜視図である。 It is an exploded perspective view of the articular surface replacement assembly having a tether. 可撓鞘を有する関節面置換アッセンブリの分解斜視図である。 It is an exploded perspective view of the articular surface replacement assembly having a flexible sheath. 本発明の第4の実施形態による、脊柱内に配置し、椎骨の後部要素に置き換えるよう構成された、人工器官の斜視図である。 According to a fourth embodiment of the present invention, positioned within the spinal column, which is configured to replace the posterior elements of the vertebrae is a perspective view of the prosthesis. 関節面置換装置で用いる経椎弓板ファスナの分解斜視図である。 Is an exploded perspective view of the through lamina fastener used in the articular surface replacement device. 椎骨の後部要素に置き換えるため人工器官を装着するための装置の斜視図である。 It is a perspective view of a device for mounting a prosthesis for replacing the posterior elements of the vertebrae.

Claims (21)

  1. 1つ又は複数の椎骨後部構造体が切除されて残った空間に間置するための人工器官において、 In prostheses for one or more of vertebral rear structure to interposition the remaining space is cut,
    切除された椎弓板に置き換えるための、下部分を有する椎弓板ブリッジと、 To replace the resected lamina, and lamina bridge with the lower portion,
    前記椎弓板ブリッジの前記下部分に接続されている、少なくとも1つの下関節面置換装置と、 Is connected to the lower portion of the lamina bridge, and at least one inferior facet replacement device,
    少なくとも1つの上関節面置換装置と、を備えており、 And joint surface replacement device at least one upper, provided with a,
    前記少なくとも1つの上関節面置換装置は、前記少なくとも1つの下関節面置換装置と関節運動を行う、人工器官。 Wherein at least one of the upper articular surface replacement device performs at least one inferior facet replacement device and articulation prosthetic.
  2. 前記少なくとも1つの下関節面置換装置は、前記椎弓板ブリッジと一体に接続されている、請求項1に記載の人工器官。 Wherein the at least one inferior facet replacement device, the connected to the lamina bridge integral prosthesis as claimed in claim 1.
  3. 前記少なくとも1つの下関節面置換装置は、前記椎弓板ブリッジと螺合接続されている、請求項1に記載の人工器官。 Wherein the at least one inferior facet replacement device, the lamina bridges and are threaded connection, prosthesis as claimed in claim 1.
  4. 前記少なくとも1つの下関節面置換装置は、前記少なくとも1つの上関節面置換装置と接触する球状部分を備えている、請求項1に記載の人工器官。 Wherein the at least one inferior facet replacement device, the has a spherical portion in contact with at least one upper articulation surface replacement device A prosthesis as claimed in claim 1.
  5. 前記少なくとも1つの下関節面装置と前記少なくとも1つの上関節面装置の間の関節運動範囲を制御するための動作拘束機構を更に備えている、請求項1に記載の人工器官。 Wherein the at least one further comprising the operation restraining mechanism for controlling the articulation range between said lower joint surface device at least one upper articulation surface device, prosthesis as claimed in claim 1.
  6. 前記動作拘束機構は、前記少なくとも1つの下間接面置換装置と前記少なくとも1つの上関節面置換装置の間を伸張する係留紐を備えている、請求項5に記載の人工器官。 The operation restraining mechanism, the includes at least one tether extending between the lower indirect surface replacement device and the at least one upper articulation surface replacement device A prosthesis as claimed in claim 5.
  7. 前記動作拘束機構は、前記少なくとも1つの下関節面置換装置と前記少なくとも1つの上関節面置換装置を少なくとも部分的には覆って伸張する鞘を備えている、請求項5に記載の人工器官。 The operation restraining mechanism, the comprises a sheath that extends over at least partially at least one of the lower joint surface replacement device said at least one upper articulation surface replacement device A prosthesis as claimed in claim 5.
  8. 前記動作拘束機構は、ヒドロゲル含んでいる、請求項5に記載の人工器官。 The operation restraining mechanism includes a hydrogel prosthesis of claim 5.
  9. 前記椎弓板ブリッジに固定的に接続され、少なくとも1つの隣接する椎骨に可動的に接続されている、可撓性を有するバンパを更に備えている、請求項1に記載の人工器官。 Said lamina bridge is fixedly connected, it is movably connected to at least one adjacent vertebrae, further comprising a bumper having a flexible prosthesis as claimed in claim 1.
  10. 前記可撓性を有するバンパは、前記少なくとも1つの隣接する椎骨に可動的に接続させるための少なくとも1つのノッチを備えている、請求項9に記載の人工器官。 Bumper having a flexible, said at least one to the adjacent vertebrae comprising at least one notch for movably connecting prosthesis as claimed in claim 9.
  11. 前記可撓性を有するバンパは、ヒドロゲルで形成されている、請求項9に記載の人工器官。 Bumper having the flexible is formed of a hydrogel prosthesis of claim 9.
  12. 前記バンパと前記少なくとも1つの隣接する椎骨の間の動作を拘束するために、前記可撓性を有するバンパを通して伸張するバンパ取り付け装置を更に備えている、請求項9に記載の人工器官。 The operation to restrain the between bumper and said at least one adjacent vertebrae further includes a bumper mounting apparatus extending through the bumper with the flexible prosthesis as claimed in claim 9.
  13. 前記椎弓板ブリッジを椎骨に固定するための少なくとも1つの椎弓根ねじを更に備えている、請求項1に記載の人工器官。 The vertebral the lamina bridge further comprises at least one pedicle screw for securing to the vertebrae, the prosthesis according to claim 1.
  14. 少なくとも2つの隣接する椎骨から1つ又は複数の椎骨後部構造体が切除されて残った空間に間置するための複数レベルの人工器官において、 In multilevel prosthesis for one of at least two adjacent vertebrae or vertebral rear structure to interposition the remaining space is cut,
    少なくとも1つの第1下関節面置換装置に接続されている第1椎弓板ブリッジと、 A first lamina bridge connected to the at least one first lower articular surface replacement device,
    少なくとも1つの上関節面伸張部に接続されている第2椎弓板ブリッジと、を備えており、 A second lamina bridge connected to at least one of the upper articular surface extension portion is provided with a,
    前記少なくとも1つの下関節面置換装置は、前記少なくとも1つの上関節面伸張部と関節運動を行う、複数レベルの人工器官。 Wherein the at least one inferior facet replacement device, the performing the articulation at least one upper articulation surface decompression unit, multiple levels of the prosthesis.
  15. 少なくとも1つの上関節面置換装置を更に備えており、前記第2椎弓板ブリッジは少なくとも1つの第2下関節面置換装置に接続され、前記少なくとも1つの第2下関節面置換装置は、前記少なくとも1つの上関節面置換装置と関節運動を行う、請求項14に記載の複数レベルの人工器官。 Further comprises at least one upper articulation surface replacement device, the second lamina bridge is connected to at least one of the second lower articular surface replacement device, the at least one second lower articular surface replacement device, the performing at least one of the upper articular surface replacement device and the articulation, multiple levels of prosthesis according to claim 14.
  16. 前記第1椎弓板ブリッジに固定的に接続されている第1の可撓性を有するバンパと、 And the bumper having a first flexible, which is fixedly connected to the first lamina bridge,
    前記第2椎弓板ブリッジに固定的に接続されている第2の可撓性を有するバンパと、を備えており、 Equipped with a bumper having a second flexible, which is fixedly connected to the second lamina bridge,
    前記第1の可撓性を有するバンパは、前記第2の可撓性を有するバンパと可動的に接続されている、請求項14に記載の複数レベルの人工器官。 The bumper having a first flexible, said second flexibility being bumper and movably connected with, multiple levels of prosthesis according to claim 14.
  17. 1つ又は複数の関節面が切除されて残った空間に間置するための人工器官において、 In prostheses for one or more articular surface is interpositional the remaining space is cut,
    第1の椎骨の椎弓板を通して伸張可能で、且つこれに接続されている少なくとも1つの経椎弓板ファスナと、 Extendable through lamina of the first vertebra, and at least one through lamina fasteners are and connected thereto,
    前記経椎弓板ファスナに接続された少なくとも1つの下関節面置換装置と、を備えている人工器官。 Wherein after at least one prosthesis comprises a, a lower articular surface replacement device connected to the lamina fastener.
  18. 第2の椎骨に接続された少なくとも1つの上関節面置換装置を更に備えており、前記少なくとも1つの上関節面置換装置は、前記少なくとも1つの下関節面置換装置と関節運動を行う、請求項17に記載の人工器官。 Further comprises at least one upper articulation surface replacement device is connected to a second vertebra, the at least one upper articulation surface replacement device performs at least one inferior facet replacement device and articulation, claim prosthesis as claimed in 17.
  19. 前記少なくとも1つの経椎弓板ファスナには第1の雄ねじ部が設けられ、前記少なくとも1つの下関節面置換装置には雌ねじ部が設けられており、且つ、前記経椎弓板ファスナは前記少なくとも1つの下関節面置換装置に螺合接続されている、請求項17に記載の人工器官。 Wherein at least one through lamina fastener is provided a first external thread portion, wherein the at least one inferior facet replacement device is provided with a female thread portion, and the through lamina fastener at least one is threaded connection to the inferior facet replacement device a prosthesis as claimed in claim 17.
  20. 前記少なくとも1つの経椎弓板ファスナには、前記第1の椎骨の椎弓板に螺合接続させるための第2の雄ねじ部が設けられている、請求項19に記載の人工器官。 Wherein at least one through lamina fastener, the second male threaded portion for threaded connection to the lamina of the first vertebra is provided, the prosthesis according to claim 19.
  21. 少なくとも1つの経椎弓板ファスナと少なくとも1つの下関節面置換装置とを有する関節面人工器官を、脊柱への侵襲性をできる限り抑えながら設置するための装置において、 The articular surfaces prosthesis having at least one through laminae fastener and at least one inferior facet replacement device, the device for installation while suppressing as much as possible the invasiveness to the spinal column,
    前記少なくとも1つの経椎弓板ファスナを脊柱の1つの椎骨の椎弓板の近くに前進させ、前記少なくとも1つの経椎弓板ファスナを前記椎弓板内へと伸張させるための第1の管状部材であって、前記少なくとも1つの経椎弓板ファスナの接続部分は前記椎弓板を通って伸張している、第1の管状部材と、 Wherein at least one through lamina fastener is advanced close to the lamina of one vertebra of the spinal column, a first tubular for stretching and said at least one through lamina fastener to said lamina in a member, the connecting portion of the at least one through lamina fasteners are stretched through the lamina, a first tubular member,
    前記少なくとも1つの下関節面置換装置を、前記少なくとも1つの経椎弓板ファスナの前記接続部分に接続するための第2の管状部材と、を備えている装置。 Wherein at least one inferior facet replacement device, and a, a second tubular member for connection to said connecting portion of said at least one through lamina fastener apparatus.
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